Medical Director -National Accounts
Core
Operational Medical Director for care management models serving National Account clients, focusing on improving health outcomes, quality, and cost.
Role type
Senior IC Medical Director (National Accounts)
Builds
Care management models and utilization review processes for National Account clients
Domain
Health insurance / National Accounts / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Utilization review, Case management, Clinical policy implementation, Multidisciplinary team leadership, Peer-to-peer provider outreach, State-specific regulatory compliance, Benefit design consultation
Preferred skills
Population health management, Health insurance industry knowledge, National Accounts segment experience, Primary/Internal Medicine/Pediatrics/Surgery board certification
Technologies
None explicitly stated
Responsibilities
Conduct daily case reviews for utilization and case management issues, Lead multidisciplinary rounds for complex clinical management, Provide clinical expertise in utilization review and case management, Identify and manage medical utilization trends and market changes, Support clinical vision and implementation for health improvement, Ensure compliance with state-specific requirements
Seniority
Director level, hands-on clinical leadership